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Collision sellar lesions: experience with eight cases and review of the literature.

Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A - Pituitary (2009)

Bottom Line: In fact, most combinations have been described before, but an overview with information on the frequency of combined pathologies in a large series has not been published.The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions.Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental occurrence rather doubtful.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, G. Gennimatas Athens General Hospital, 154 Messogion Ave, 115 27, Athens, Greece. mkoutourousiou@yahoo.gr

ABSTRACT
The concomitant presence of a pituitary adenoma with a second sellar lesion in patients operated upon for pituitary adenoma is an uncommon entity. Although rare, quite a great variety of lesions have been indentified coexisting with pituitary adenomas. In fact, most combinations have been described before, but an overview with information on the frequency of combined pathologies in a large series has not been published. We present a series of eight collision sellar lesions indentified among 548 transsphenoidally resected pituitary adenomas in two Neurosurgical Departments. The histological studies confirmed a case of sarcoidosis within a non-functioning pituitary adenoma, a case of intrasellar schwannoma coexisting with growth hormone (GH) secreting adenoma, two Rathke's cleft cysts combined with pituitary adenomas, three gangliocytomas associated with GH-secreting adenomas, and a case of a double pituitary adenoma. The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions. Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental occurrence rather doubtful. Suggested hypotheses about a common embryonic origin or a potential interaction between pituitary adenomas and the immune system are presented.

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Patient No. 8. Ganglion cells admixed with acidophil cells of a densely granulated somatotroph adenoma. Note the presence of prominent nucleoli in ganglion cell and the fibrillary neuropil in the stroma. Hematoxylin & Eosin staining ×20
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Fig3: Patient No. 8. Ganglion cells admixed with acidophil cells of a densely granulated somatotroph adenoma. Note the presence of prominent nucleoli in ganglion cell and the fibrillary neuropil in the stroma. Hematoxylin & Eosin staining ×20

Mentions: The histological studies defining the concomitance of a pituitary adenoma with a second sellar lesion are summarised in Table 1. The histological diagnosis confirmed a case of sarcoidosis within a non-functioning pituitary adenoma (NFPA) (Fig. 1), three cases of gangliocytoma associated with GH-secreting pituitary adenoma (Figs. 2, 3), a schwannoma coexisting with GH-secreting adenoma, a case of double adenoma consisting of a GH-secreting adenoma and a prolactinoma (Fig. 4), and two Rathke’s cleft cysts (RCC) with a concomitant pituitary adenoma, specifically an ACTH-secreting and a NFPA adenoma (Fig. 5). The case of intrasellar schwannoma coexisting with a GH-secreting adenoma has already been accepted for publication. In case of neurosarcoidosis within an adenoma, the final diagnosis was definite when systemic pulmonary disease was determined, 3 years after the initial operation.Table 1


Collision sellar lesions: experience with eight cases and review of the literature.

Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A - Pituitary (2009)

Patient No. 8. Ganglion cells admixed with acidophil cells of a densely granulated somatotroph adenoma. Note the presence of prominent nucleoli in ganglion cell and the fibrillary neuropil in the stroma. Hematoxylin & Eosin staining ×20
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2807600&req=5

Fig3: Patient No. 8. Ganglion cells admixed with acidophil cells of a densely granulated somatotroph adenoma. Note the presence of prominent nucleoli in ganglion cell and the fibrillary neuropil in the stroma. Hematoxylin & Eosin staining ×20
Mentions: The histological studies defining the concomitance of a pituitary adenoma with a second sellar lesion are summarised in Table 1. The histological diagnosis confirmed a case of sarcoidosis within a non-functioning pituitary adenoma (NFPA) (Fig. 1), three cases of gangliocytoma associated with GH-secreting pituitary adenoma (Figs. 2, 3), a schwannoma coexisting with GH-secreting adenoma, a case of double adenoma consisting of a GH-secreting adenoma and a prolactinoma (Fig. 4), and two Rathke’s cleft cysts (RCC) with a concomitant pituitary adenoma, specifically an ACTH-secreting and a NFPA adenoma (Fig. 5). The case of intrasellar schwannoma coexisting with a GH-secreting adenoma has already been accepted for publication. In case of neurosarcoidosis within an adenoma, the final diagnosis was definite when systemic pulmonary disease was determined, 3 years after the initial operation.Table 1

Bottom Line: In fact, most combinations have been described before, but an overview with information on the frequency of combined pathologies in a large series has not been published.The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions.Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental occurrence rather doubtful.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, G. Gennimatas Athens General Hospital, 154 Messogion Ave, 115 27, Athens, Greece. mkoutourousiou@yahoo.gr

ABSTRACT
The concomitant presence of a pituitary adenoma with a second sellar lesion in patients operated upon for pituitary adenoma is an uncommon entity. Although rare, quite a great variety of lesions have been indentified coexisting with pituitary adenomas. In fact, most combinations have been described before, but an overview with information on the frequency of combined pathologies in a large series has not been published. We present a series of eight collision sellar lesions indentified among 548 transsphenoidally resected pituitary adenomas in two Neurosurgical Departments. The histological studies confirmed a case of sarcoidosis within a non-functioning pituitary adenoma, a case of intrasellar schwannoma coexisting with growth hormone (GH) secreting adenoma, two Rathke's cleft cysts combined with pituitary adenomas, three gangliocytomas associated with GH-secreting adenomas, and a case of a double pituitary adenoma. The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions. Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental occurrence rather doubtful. Suggested hypotheses about a common embryonic origin or a potential interaction between pituitary adenomas and the immune system are presented.

Show MeSH
Related in: MedlinePlus